Basic Information
| Provider Information | |||||||||
| NPI: | 1952336414 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BIETER SCHULTZ | ||||||||
| FirstName: | DEBORAH | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1109 | ||||||||
| Address2: | 450 CRESSON BLVD SUITE 300 | ||||||||
| City: | OAKS | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194561109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6104824778 | ||||||||
| FaxNumber: | 6106663310 | ||||||||
| Practice Location | |||||||||
| Address1: | 495 THOMAS JONES WAY | ||||||||
| Address2: | BAXTER BLDG 2 SUITE 210 | ||||||||
| City: | EXTON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 193412553 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6102803636 | ||||||||
| FaxNumber: | 6102801569 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2006 | ||||||||
| LastUpdateDate: | 10/16/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 25MA06665600 | NJ | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | OS005632L | PA | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 7653701 | 05 | NJ | MEDICAID | 3319674 | 01 | NJ | AETNA ID NUMBER | OTHER | 3K4525 | 01 | NJ | HEALTHNET ID NUMBER | OTHER | 10651933 | 01 | NJ | CAQH NUMBER | OTHER |